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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* **Hyperphosphatemia in End-Stage Renal Disease (ESRD):** To reduce serum phosphate levels in patients undergoing dialysis.
## Adult Dosing
* **Initial Dose:** Typically 2 tablets (667 mg elemental calcium per tablet) taken orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels.
* **Maximum Dose:** Generally not to exceed 12 tablets per day.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized based on clinical response and serum phosphate levels. Consultation with a pediatric nephrologist is recommended.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is not typically required in patients with CKD, as the drug is used to manage hyperphosphatemia in this population. However, monitoring for hypercalcemia is crucial.
* **Hepatic Impairment:** No specific dose adjustments are typically needed.
## Contraindications
* Hypercalcemia
* Hypersensitivity to calcium acetate or any component of the formulation.
* Use in patients with ESRD on dialysis who have a serum calcium level above the normal range.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Hypercalcemia (symptoms include confusion, lethargy, muscle weakness, cardiac arrhythmias, constipation, nausea, vomiting, increased urination, thirst).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids containing magnesium or aluminum:** Concurrent use may increase the risk of hypermagnesemia or aluminum toxicity.
## Monitoring
* **Serum Phosphate Levels:** Monitor regularly to assess efficacy.
* **Serum Calcium Levels:** Monitor frequently, especially during initial titration and dose adjustments, to prevent hypercalcemia. Target serum calcium levels should be determined by the prescriber.
* **Alkaline Phosphatase:** Monitor for bone disease.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Advise patients to report symptoms of hypercalcemia immediately.
* Dosing is based on the number of tablets, each containing 667 mg of calcium acetate, which provides 169 mg of elemental calcium.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and guidelines for complete details and to verify specific dosing and safety recommendations before initiating or modifying therapy.
